Individual
LOGAN MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
187 COLUMBUS RD, ATHENS, OH 45701-1315
(740) 593-3191
Mailing address
1617 HORNBECK RD, MORGANTOWN, WV 26508-4757
(304) 685-2753
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT.006901
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT.006901
LICENSE NUMBER
OH
Enumeration date
06/19/2020
Last updated
06/19/2020
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